The Last Word
Covino, Susan
THE LAST WORD Susan Covino To Die in Peace When I first met her six years ago, she was walking her Schnauzer, Zacky. Dora was eighty-four years old, had been widowed about thirty years, and was...
...run an article on the inadequacies of nursing-home care...
...Worse still, some advocates of the "right to life" have criticized the Presidential panel's recommendation that patients be permitted to refuse high-technology life-support systems...
...Fortunately, Dora was spared some of the worst abuses of the system...
...Technology, medical bureaucracy, and politics seem to be conspiring to deprive us of our rights in our own dying...
...By then, she had to contend not only with the indignities visited on her by the disease, but with other forces arrayed against her as well...
...There are sixty patients here and a cook provides sixty different meals every day...
...After her first few days, Dora confirmed that the quality of the care was good...
...The fracture made her last months miserable, and she died a few weeks after surgery to mend her hip...
...Shortly after Dora's death, I read about recommendations issued by a White House panel on the care of the terminally ill...
...It occurred to me that the phenomenal growth of such technology—and of the corps of professionals to administer it—has taken the whole process of dying out of the hands of DAVID JOHNSON the patient and family...
...Her attendant remarked, "Dora just isn't herself today...
...And her physician, who had offered little advice once her condition was diagnosed as terminal, argued that institutional care would be more "professional...
...Dying is now an issue of professional ethics, even of politics...
...Several close friends arranged to help with daily chores and to care for her when she could no longer leave her bed...
...We're on top of every patient...
...This is her first published article...
...One neighbor called her "a model of how to live...
...Dora wondered what more "professional" care would consist of...
...Until the last six months of Dora's life, the cancer had little visible effect on her...
...This isn't like the places described in the The Journal," I was assured...
...She took pride in this project, and when she completed it she told me she had just one goal left—to live long enough to bury her Schnauzer...
...Her friend took me on a tour of the place just a day or two after The Wall Street Journal had Susan Covino lives in Madison, Wisconsin...
...In fact, Dora wasn't there the next time I came...
...Had circumstances and friends allowed, she would have been a model of how to die, for she was determined to die at home with as much control over herself and her surroundings as her illness would permit...
...She needed pain pills, regular food, and baths, and these she could receive at home...
...The American health-care system breeds a mentality of turning away from this consideration, perhaps because it does not acknowledge the reality that there is a time to die...
...It was only toward the end that she became bedridden...
...We need to gain, or regain, our understanding that some of our humanity is lost when we try to deny the reality of death...
...Most of her final weeks were spent at a well-regarded nursing home...
...Like birth, death is a part of life—a part we must not lift out of the context of family, friends, neighbors, those familiar surroundings that provide comfort in the final adversity...
...Even professionals can't provide a totally controlled environment: Dora had broken her hip while getting up to go to the bathroom...
...One close friend, a nurse employed in an old people's home, was worried that Dora's neighbors would be unable to provide adequate care for her in her own home...
...She was an independent woman: She regularly rode the bus to the State Historical Society to conduct exhaustive research on her family's history...
...At times, Dora's care was solicitous to the point of intrusiveness...
...But when her children, too, urged her to take the more "professional" route, she gave in...
...Dora was eighty-four years old, had been widowed about thirty years, and was on one of the mile-long walks she took twice a day with her dog...
...She may fall and break her hip," the nurse warned...
...But her own life and death suggest to me that something has gone awry...
...Writing recently in The New England Journal of Medicine, one physician observed: "My personal experience in the practice of neurology for over twenty years is that there is widespread refusal to acknowledge the suffering and degradation experienced by helpless people permanently maintained with life-support systems...
...Her savings were sufficient to provide part-time nursing care once the burden for friends became too great...
...My hair is washed every day—whether I want it or not," she said...
...One day I found her in pain and depressed...
...With typical thoroughness, she began planning her departure...
...Maybe I won't be here the next time you come...
...The panel suggested that "health care providers" consider the wishes of the terminally ill in the use of such devices as dialysis machines and respirators...
...Two years ago, Dora learned she had terminal cancer...
...I wish this would end," she said...
Vol. 48 • February 1984 • No. 2
